Healthcare Provider Details

I. General information

NPI: 1508158403
Provider Name (Legal Business Name): BEATRICE ADENIKE OGUNDIMU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SIENNA VISTA CT
RENO NV
89512-1370
US

IV. Provider business mailing address

204 MARSH AVE
RENO NV
89509-1652
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-1580
  • Fax:
Mailing address:
  • Phone: 775-972-9191
  • Fax: 775-972-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: